ED drugs not working? You may be using them wrong

New research from Spain says many men fail to respond to erectile dysfunction medications correctly. The study was done by Dr. Borja Garcia Gomez at the Hospital Universitario in Madrid and published in the journal Urology. According to the study, 69% of men report that their erectile dysfunction persisted after taking PDE5 inhibitors including Viagra, Cialis and Levitra. Researchers offered patients a “re-education” program to help them better understand how to use the medications.

Researchers recruited 250 men who all reported that their ED medications were not helping. The participants were given surveys to measure the severity of their erectile dysfunction on a scale from 0 to 25 (higher meaning better function). Before being re-educated, the average score was 13. They were also interviewed to determine exactly how they were using the drugs. Of the 250 men, 172 were not taking them under optimal conditions. Therefore, those 172 were offered the re-education program to learn how to take the drugs for the best possible outcome.

Of the 172 men, 57 dropped out of the study for various reasons. Of the 115 who did participate in the re-education program, 88 responded with good results. The average ED score increased to above 24. The researchers concluded that men are not given enough information about how to use their ED drugs when they are initially prescribed to them. This is especially true if men don’t inform their doctors about their ED issue until last minute during their visit. (Many men are afraid and embarrassed to bring it up and either barely mention it or don’t bring it up at all).

Researchers and Dr. Jacob Rajfer, MD, professor of urology at the David Geffen School of Medicine at UCLA came up with the following reasons and advice for taking ED drugs properly:

  1. 1.    Sexual arousal is key. 3% of men in the study said they weren’t getting enough sexual stimulation when trying them out. When sexually excited, the brain sends signal via the nerves down to the penis. This releases a chemical into the penis which activates the production of the chemical that the drugs work on to produce an erection. If a man is not aroused, that second chemical will never be activated.
  2. 2.    Take more than the minimal dosage. 31% of men in study assumed their ED drugs didn’t work before testing out the maximum dosage. Researchers say that for the majority of men who complain about ED, the drugs are going to work at higher dosage. However, if you have hypertension, diabetes, or high cholesterol, your will probably start with a lower dose to be safe. Otherwise, researchers say to ask doctor if the prescription is for the maximum dose.
  3. 3.    Don’t eat before taking your ED medication. Over 20% of men in study took Viagra or Levitra right after eating. On a full stomach, only half of the drugs get absorbed. Viagra and Levitra work best on an empty stomach. Wait at least 2-3 hours after eating a full meal to take them. This is not true for Cialis.
  4. 4.    After taking your ED medication, wait a little while to have sex. 1 in 6 men in study reported attempting to have sex too soon after taking their ED meds. For Viagra and Levitra, wait at least one hour before having sex. This is when these drugs are at their highest efficacy in your body. Cialis works best two to three hours after ingestion.
  5. 5.    Try more than one type of ED medication. 40% of men in the study didn’t try another kind of ED medication after the first was unsuccessful. This was the most common mistake made in the study. Every patient responds differently to different drugs so it’s important to discuss with your doctor and try more than one to see which works best for you.
  6. 6.    Test each type out a few times. 33% of men in study did not try the medication at least 6 times – the standard recommendation. Try taking it a few times before assuming it doesn’t work to rule out any related factors such as not enough sexual arousal or being too full.


Doctors should take their time when explaining to their patients how these drugs work. They should also follow-up with them to make sure that their patients are getting the most out of that particular treatment. Patients should also not feel scared or embarrassed to discuss their ED issue with their urologist or any type of healthcare provider at their urologist’s office so the information can be relayed to the doctor. After various oral medications do not work, patients can then discuss other ED treatment options such as a penile injection, suppository, pump, or surgery.

David Samadi, MD - Medical Contributor

View posts by David Samadi, MD - Medical Contributor
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team. Learn more at roboticoncology.com. Visit Dr. Samadi's blog at SamadiMD.com. Follow Dr. Samadi on Twitter, Instagram, Pinterest, and Facebook.

1 Comment

  1. John S ThomasDecember 14, 2014

    My wife and I love your program on Fox. Does age have anything to do with ED. I am 78 years old.

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